CC PART 2 Flashcards by SHEEN CLARK S. CABA�EROS

Given the following serum electrolyte data, determine the anion gap:
Na = 132 mmol/L; Cl = 90 mmol/L; HCO3 = 22 mmol/L

a. 12 mmol/L
b. 20 mmol/L
c. 64 mmol/L
d. Insufficient Information

b. 20 mmol/L

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This Lecithin-sphingomyelin ratio is associated with a high risk of infant respiratory distress syndrom.

A. Less than 1.5
B. Less than 2.0
C. More than 1.5
D. More than 2.0

A. Less than 1.5

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Which of the following conditions is associated with increase ionized calcium (Ca1) in the blood?

a. Alkalosis
b. Hypoparathyroidism
c. Hyperalbuminemia
d. Malignancy

d. Malignancy

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Which of the following laboratory results is consistent with primary hypoparathyroidism?

A. Low calcium; high inorganic phosphorus (P1)
B. Low calcium; low P1
C. High calcium; high P1
D. High calcium; low P1

A. Low calcium; high inorganic phosphorus (P1)

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This statement is FALSE regarding measurements of heme pigments?

A. Coproporphyrins (CP) extracted from buffered urine into ether or ethyl acetate at pH 4.8
B. For total CP, convert coproporphyrinogen (CPG) to Coproporphyrins (CP) by lowering urine pH
C. For total UP convert uroporphyrinogen (UPG) to Coproporphyrin (CP) by heat
D. Porphobilinogen (UBG) will react with erhlich’s reagent (p-dimethylaminobenzaldehyde) to form red color

C. For total UP convert uroporphyrinogen (UPG) to Coproporphyrin (CP) by heat

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Which of the following values is the threshold critical value (alert or action level) for low plasma potassium?

A. 150 mmol/L
B. 2.0 mmol/L
C. 2.5
D. 3.5 mmol/L

C. 2.5

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Which of the following values is the threshold critical value (alert or action level) for high plasma sodium?

a. 150 mmol/L
b. 160 mmol/L
c. 170 mmol/L
d. 180 mmol/L

b. 160 mmol/L

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When performing a sweat chloride collection, which of the following steps will result in analytical error?

A. Using inweighed gauze soaked in pilocarpine nitrate on the inner surface of the forearm
B. Using outweighed gauze soaked in saline on the outside of the arm
C. Leaving the preweighed gauze on the inside of the arm exposed to air during collection
D. Rinsing the collected sweat from the gauze pad using chloride titrating solution

C. Leaving the preweighed gauze on the inside of the arm exposed to air during collection

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Which formula is most accurate in predicting plasma osmolality?

A. Na + 2(CI) + BUN + glucose
B. 2(Na) + 2(CI) + glucose + urea
C. 2(Na) + glucose÷18 + BUN÷2.8
D. Na + CI + K + HCO3

C. 2(Na) + glucose÷18 + BUN÷2.8

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Which of the following results falls within the diagnostic criteria for diabetes mellitus?

a. fasting plasma glucose level of 120 mg/dL
b. two-hour post-prandial plasma glucose of 160 mg/dL
c. two-hour plasma glucose reading of 190 mg/dL flowing 75 oral glucose challenge
d. random plasma glucose of 250 mg/dL and presence of symptoms

d. random plasma glucose of 250 mg/dL and presence of symptoms

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Which statement regarding gestational diabetes mellitus (GDM) is correct?

A. it is diagnosed using the same oral glucose tolerance criteria as used in nonpregnancy
B. it converts to diabetes mellitus after pregnancy in 60%-75% of case
C. it presents no increased health risk of the fetus
D. it is defined as glucose intolerance originating during pregnancy

D. it is defined as glucose intolerance originating during pregnancy

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Which statement regarding glycated (glycosylated) hemoglobin (G-Hgb) is true?

A. It has a sugar attached to the C-terminal end of the B-chain
B. It is a highly reversible aminoglycan
C. It reflects the extent of glucose regulation in the 8 to 12 week interval prior to sampling
D. It will be abnormal within 4 days following an episode of hypeglycemia

C. It reflects the extent of glucose regulation in the 8 to 12 week interval prior to sampling

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A technologist is performing an enzyme at 340 nm using a visible range spectrophotometer. After setting the wavelength and adjusting the readout to zero %T with the light path blocked, a cuvet with deionized water is inserted. With the light path fully open and the 100%T control at maximum, the instruments readout will not rise above 90%T. What is the most appropriate first course of action?

a. replace the source lamp
b. insert a wider cuvet into the light path
c. measure the voltage across the lamp terminals
d. replace the instrument fuse

a. replace the source lamp

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Why do many optical systems in chemistry analyzers utilize a reference light paths?

A. To increase the sensitivity of the measurement
B. To minimize error caused by source lamp fluctuation
C. To obviate the need for wavelength adjustment
D. To reduce stray light effects

B. To minimize error caused by source lamp fluctuation

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Internal standards are not needed in atomic absorption spectrophotometry because:

A. Changes in aspiration have little effect on the number of ground state atoms
B. atomic absorption instruments have a stable light path
C. The instrument measures only one atom at a time
D. The instrument source lamp is used for a reference voltage

C. The instrument measures only one atom at a time

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The ion-selective membrane used to measure potassium is made of:

a. High-borosilicate glass membrane
b. Polyvinyl chloride dioctylphenyl phosphate ion exchanger
c. Valinomycin gel
d. Calomel

c. Valinomycin gel

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A sample of deionized water is found to contain a lead concentration of 0.01 ppm. What is the equivalent concentration expressed as milligrams per deciliter?

A. 0.01
B. 0.001
C. 0.0001
D. 0.000001

B. 0.001

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The term reverse phase is used in HPLC to indicate that the mobile phase is:

A. More polar than the stationary phase
B. Liquid and the stationary phase is solid
C. Organic and stationary phase is aqueous
D. A stronger solvent than the stationary phase

A. More polar than the stationary phase

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What is the purpose of an internal standard in HPLC and GC methods?

A. It compensates for variation in extraction and injection
B. It corrects for background absorbance
C. It compensates for changes in flow rate
D. It corrects for coelution of solutes

A. It compensates for variation in extraction and injection

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Which of the following situations is likely to cause an error when weighing with an electronic analytical balance?

a. failure to keep the knife edge clean
b. failure to close the doors of the balance before reading the weight
c. oxidation on the surface of the substitution weights
d. using the balance without allowing it to warm up at least 10 minutes

b. failure to close the doors of the balance before reading the weight

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What is the blood pH when the partial pressure of carbon dioxide (Pco2) is 60 mmHg and the bicarbonate level is 18 mmol/L?

A. 6.89
B. 7.00
C. 7.10
D. 7.30

C. 7.10

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Which of the following effects results from exposure of a normal arterial blood sample to room air?

a. Po2 increased Pco2 decreased pH increased
b. Po2 decreased Pco2 increased pH decreased
c. Po2 increased Pco2 decreased pH decreased
d. Po2 decreased Pco2 decreased pH decreased

a. Po2 increased Pco2 decreased pH increased

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A patient’s blood gas results are as follows: pH = 7.26; dco2 = 2.0 mmol/L; HCO3 = 29 mmol/L. These results would be classified as:

A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis

C. Respiratory acidosis

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In which condition would hypochloremia be expected?

A. Respiratory alkalosis
B. Metabolic acidosis
C. Metabolic alkalosis
D. All of the above

C. Metabolic alkalosis

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25. Which of the following plots is best for detecting all types of QC erros? a. Levy-Jennings b. Tonks-Youden c. Cusum d. Linear regression

a. Levy-Jennings

26. Which of the following plots is best for comparison of precision and accuracy among laboratories? a. Levy-Jennings b. Tonks-Youden c. Cusum d. Linear regression

b. Tonks-Youden

27. Which plot will give the earliest indication of a trend? a. Levy-Jennings b. Tonks-Youden c. Cusum d. Linear regression

c. Cusum

28. A new tumor marker for ovarian cancer is evaluated for sensitivity by testing serum samples from patients who have been diagnosed by staging biopsy as having malignant or benign lesions. The following results were obtained: Number of malignant patients who are positive for CA-125 = 21 out of 24 Number of benign patients who are negative for CA-125 = 61 out of 62 What is the sensitivity of the new CA-125 test? A. 98.4% B. 95.3% C. 87.5% D. 85.0%

C. 87.5%

29. A laboratory is establishing a reference range for a new analyte and wants the range to be determined by the regional population of adults age 18 and older. The analyte concentration is known to be independent of race and gender. Which is the most appropriate process to follow? A. Determine the mean and standard deviation of the analyte from 40 healthy adults and calculate the +_2 standard deviation limit B. Measure the analyte in 120 healthy adults and calculate the central 95th percentile C. Measure the analyte in 120 healthy adults and use the lowest ad highest as the reference range limits D. Measure the analyte in 60 healthy adults and 60 adults with conditions that affect the analyte concentration. Calculate the concentration of least overlap

B. Measure the analyte in 120 healthy adults and calculate the central 95th percentile

30. Which of the following conditions is most likely to cause a falsely high creatinine clearance result? A. The patient uses the midstream void procedure when collecting his or her urine B. The patient adds tap water to the urine container because he or she forgets to save one of the urine samples C. The patient does not empty his or her bladder at the conclusion of the test D. The patient empties his or her bladder at the start of the test and adds the urine to the collection

D. The patient empties his or her bladder at the start of the test and adds the urine to the collection

31. Given the following data, calculate the creatinine clearance: Serum creatinine = 1.2 mg/dL Urine creatinine = 120 mg/dL Urine volume = 1.75 L/day Surface area = 1.80 m² A. Creatinine clearance = 16 mL/min B. Creatinine clearance = 117 mL/min C. Creatinine clearance = 126 mL/min D. Creatinine clearance = 168 mL/min

B. Creatinine clearance = 117 mL/min

32. Select the primary reagent used in the Jaffe method for creatinine. A. Alkaline copper II sulfate B. Saturated picric acid and NaOH C. Sodium nitroprusside and phenol D. Phosphotungstic acid

B. Saturated picric acid and NaOH

33. Urinary urea measurements may be used for calculation of: A. Glomerular filtration B. Renal blood flow C. Nitrogen balance D. All of the above

C. Nitrogen balance

34. Which enzyme deficiency is responsible for phenylketonuria (PKU)? A. Phenylalanine hydroxylase B. Tyrosine transaminase C. p-Hydroxyphenylpyruvic acid oxidase D. Homogentisic acid oxidase

A. Phenylalanine hydroxylase

35. Which aminoaciduria results in the overflow of branched chain amino acids? A. Hartnup’s disease B. Alkaptonuria C. Homocystinuria D. Maple syrup urine disease

D. Maple syrup urine disease

36. Of the methods used to measure amino acids, which is capable of measuring only phenylalanine? A. Tandem mass spectroscopy B. High-performance liquid chromatography C. Capillary electrophoresis D. Fluorometric analysis with Ninhydrin

D. Fluorometric analysis with Ninhydrin

37. Which glucose method is subject to falsely low results caused by ascorbate? A. Hexokinase B. Glucose dehydrogenase C. Trinder glucose oxidase D. Polarography

C. Trinder glucose oxidase

38. Identify the enzyme deficiency responsible for Type I glycogen storage disease (von Gierke’s disease). A. Glucose-6-phosphatase B. Glycogen phosphorylase C. Glycogen synthetase D. β-Glucosidase

A. Glucose-6-phosphatase

39. Which of the following is likely to occur first in iron deficiency anemia? A. Decreased serum iron B. Increase TIBC C. Decrease serum ferritin D. Increased transferrin

C. Decrease serum ferritin

40. Which formula provides the best estimate of serum transferrin? A. Serum Fe / TIBC B. TIBC (µg/dL) × 0.70 = transferrin in mg/dL C. Percent iron saturation × TIBC (µg/dL) / 1.2 + 0.06 D. Serum Fe (µg/dL) × 1.25 = transferrin (µg/dL)

B. TIBC (µg/dL) × 0.70 = transferrin in mg/dL

41. Which enzyme is responsible for the conjugation of bilirubin? A. β-Glucuronidase B. Uridine diphosphate (UDP)-glucuronyl transferase C. Bilirubin oxidase D. Biliverdin reductase

B. Uridine diphosphate (UDP)-glucuronyl transferase

42. Which condition is caused by deficient secretion of bilirubin into the bile canaliculi? A. Gilbert’s disease B. Neonatal hyperbilirubinemia C. Dubin-Johnson syndrome D. Crigler-Najjar syndrome

C. Dubin-Johnson syndrome

43. Which reagent is used in the Jendrassik–Grof method to solubilize unconjugated bilirubin? A. 50% Methanol B. n-Butanol C. Caffeine D. Acetic acid

C. Caffeine

44. A biuret reagent requires preparation of a stock solution containing 9.6 g of copper II sulfate (CuSO₄)/L. How many grams of CuSO₄·5H₂O are needed to prepare 1.0 L of the stock solution? (Atomic weights: H = 1.0; Cu = 63.6; O = 16.0; S = 32.1) A. 5.4 g B. 6.1 g C. 15.0 g D. 17.0 g

C. 15.0 g

45. Convert 10.0 mg/dL calcium (atomic weight = 40.1) to comparable units in the International System of Units (SI). A. 0.25 mmol/L B. 0.40 mmol/L C. 2.5 mmol/L D. 4.0 mmol/L

C. 2.5 mmol/L

46. Convert 2.0 mEq/L magnesium (atomic weight = 24.3) to milligrams per deciliter. A. 0.8 mg/dL B. 1.2 mg/dL C. 2.4 mg/dL D. 4.9 mg/dL

C. 2.4 mg/dL

47. How many milliliters of a 2000.0 mg/dL glucose stock solution are needed to prepare 100.0 mL of a 150.0 mg/dL glucose working standard? A. 1.5 mL B. 7.5 mL C. 15.0 mL D. 25.0 mL

B. 7.5 mL

48. What is the pH of a solution of HNO₃ if the hydrogen ion concentration is 2.5 × 10⁻² M? A. 1.0 B. 1.6 C. 2.5 D. 2.8

B. 1.6

49. Enzymatic measurement of ammonia requires which of the following substrates and coenzymes? Substrate, Coenzyme A. α-ketoglutarate, NADH B. Glutamate, NADH C. Glutamine, ATP D. Glutamine, NAD⁺

A. α-ketoglutarate, NADH

50. In the Oliver-Rosalki method for CK, adenosine monophosphate (AMP) is added to the substrate in order to: A. Inhibit adenylate kinase B. Block the oxidation of glutathione C. Increase the amount of ADP that is available D. Block the action of adenosine pentaphosphate

A. Inhibit adenylate kinase

51. A physician calls to request a CK on a sample already sent to the laboratory for coagulation studies. The sample is 2-hour-old citrated blood and has been stored at 4°C. The plasma shows very slight hemolysis. What is the best course of action and the reason for it? A. Perform the CK assay on the sample because no interferent is present B. Reject the sample because it is slightly hemolyzed C. Reject the sample because it has been stored too long D. Reject the sample because the citrate will interfere

D. Reject the sample because the citrate will interfere

52. In a nonmyocardial as opposed to a myocardial cause of an increased serum or plasma CK-MB, which would be expected? A. An increase in CK-MB that is persistent B. An increase in the percentage of CK-MB as well as the concentration C. The presence of increased troponin I D. A more modest increase in total CK than in CK-MB

A. An increase in CK-MB that is persistent

53. What is the typical time course for plasma troponin I following an acute MI? A. Abnormal within 3 hours; peaks within 12 hours; returns to normal in 24 hours B. Abnormal within 6 hours; peaks within 18 hours; returns to normal in 48 hours C. Abnormal within 4 hours; peaks within 24 hours; returns to normal in 1 week D. Abnormal within 6 hours; peaks within 36 hours; returns to normal in 5 days

D. Abnormal within 6 hours; peaks within 36 hours; returns to normal in 5 days

54. Select the products formed from the forward reaction of ALT: A. Aspartate and alanine B. Alanine and α-ketoglutarate C. Pyruvate and glutamate D. Glutamine and NAD⁺

C. Pyruvate and glutamate

55. Which statement accurately describes serum transaminase levels in Acute Myocardial Infarction? A. ALT is increased 5–10-fold after an acute MI B. AST peaks 24–48 hours after an acute MI and returns to normal within 4–6 days C. AST levels are usually 20–50 times the upper limit of normal after an acute MI D. Isoenzymes of AST are of greater diagnostic utility than the total enzyme level

B. AST peaks 24–48 hours after an acute MI and returns to normal within 4–6 days

56. In which liver disease is the De Ritis ratio (ALT:AST) usually greater than 1.0? A. Acute hepatitis B. Chronic hepatitis C. Hepatic cirrhosis D. Hepatic carcinoma

A. Acute hepatitis

57. Select the most sensitive marker for alcoholic liver disease: A. GLD B. ALT C. AST D. γ-Glutamyltransferase (GGT)

D. γ-Glutamyltransferase (GGT)

58. Which isoenzymes of ALP are inhibited by L-phenylalanine? A. Intestinal and placental B. Bone and intestinal C. Liver and placental D. Renal and liver

C. Liver and placental

59. Which isoenzyme of ALP migrates farthest toward the anode when electrophoresed at pH 8.6? A. Placental B. Bone C. Liver D. Intestinal

C. Liver

60. A serum from a 50-year-old man was analyzed for both prostatic acid phosphatase (PAP) and prostate-specific antigen (PSA) following a digital rectal examination of the prostate. The PAP result is 6.0 µg/L (URL = 3.0 µg/L), and the PSA is 2.0 µg/L (URL = 4.0 µg/L). Both tests are repeated on the same sample, and the results remain unchanged. What is the most likely explanation? A. The PAP is falsely elevated by prostatic irritation B. The patient has benign prostatic hypertrophy C. The patient has an infection of the prostate D. The PSA is falsely low because it is not as sensitive as the PAP

A. The PAP is falsely elevated by prostatic irritation

61. How soon following acute abdominal pain due to pancreatitis is the serum amylase level expected to rise? A. 1–2 hours B. 2–12 hours C. 3–4 days D. 5–6 days

B. 2–12 hours

62. The reference method for lipase uses olive oil as the substrate because: A. Other esterases can hydrolyze triglyceride and synthetic diglycerides B. The reaction product can be coupled to NADH-generating reactions C. Synthetic substrates are less soluble than olive oil in aqueous reagents

A. Other esterases can hydrolyze triglyceride and synthetic diglycerides

63. A serum ALP level greater than twice the elevation of GGT suggests: A. Misidentification of the specimen B. Focal intrahepatic obstruction C. Acute alcoholic hepatitis D. Bone disease or malignancy

D. Bone disease or malignancy

64. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) causes: A. Low serum vasopressin B. Hypernatremia C. Urine osmolality to be lower than that of plasma D. Low serum electrolytes

C. Urine osmolality to be lower than that of plasma

65. Select the main estrogen produced by the ovaries and used to evaluate ovarian function: A. Estriol (E₃) B. Estradiol (E₂) C. Epiestriol D. Hydroxyestrone

B. Estradiol (E₂)

66. Hyperparathyroidism is most consistently associated with: A. Hypocalcemia B. Hypocalciuria C. Hypophosphatemia D. Metabolic alkalosis

C. Hypophosphatemia

67. Orders for uric acid are legitimate stat requests because: A. Levels above 10 mg/dL cause urinary tract calculi B. Uric acid is hepatotoxic C. High levels induce aplastic anemia D. High levels cause joint pain

A. Levels above 10 mg/dL cause urinary tract calculi

68. The term “biuret reaction” refers to: A. The reaction of phenolic groups with CuSO₄ B. Coordinate bonds between Cu²⁺ and carboxyl and amino groups of biuret C. The protein error of indicator effect producing color when dyes bind protein D. The reaction of phosphomolybdic acid with protein

B. Coordinate bonds between Cu²⁺ and carboxyl and amino groups of biuret

69. Which of the following protein methods has the highest analytical sensitivity? A. Refractometry B. Folih-Lowry C. Turbidimetry D. Direct UV absorption

B. Folih-Lowry

70. High serum total protein but low albumin is usually seen in: A. Multiple myeloma B. Hepatic cirrhosis C. Glomerulonephritis D. Nephritic syndrome

A. Multiple myeloma

71. Which of the following dyes is the most specific for measurement of albumin? A. Bromcresol green (BCG) B. Bromcresol purple (BCP) C. Tetrabromosulfophthalein D. Tetrabromphenol blue

B. Bromcresol purple (BCP)

72. At pH 8.6, proteins are ______ charged and migrate toward the ______. A. Negatively, Anode B. Positively, Cathode C. Positively, Anode D. Negatively, Cathode

A. Negatively, Anode

73. Which of the following stains is used for lipoprotein electrophoresis? A. Oil Red O B. Coomassie Brilliant Blue C. Amido Black D. Ponceau S

A. Oil Red O

74. Select the order of mobility of lipoproteins electrophoresed on cellulose acetate or agarose at pH 8.6. A. -chylomicrons→pre-β→β→α + B. -β→pre-β→α→chylomicrons + C. -chylomicrons→β→pre-β→α + D. -α→β→pre-β→chylomicrons +

C. -chylomicrons→β→pre-β→α +

75. Which apoprotein is inversely related to risk for coronary heart disease? A. Apoprotein A-I B. Apoprotein B C. Apoprotein C-II D. Apoprotein E-IV

A. Apoprotein A-I

76. What is the most appropriate fasting procedure when a lipid study of triglycerides, total cholesterol, HDL cholesterol, and LDL cholesterol tests are ordered? A. 8 hours, nothing but water allowed B. 10 hours, water, smoking, coffee, tea (no sugar or cream) allowed C. 12 hours, nothing but water allowed D. 16 hours, water, smoking, coffee, tea (no sugar or cream) allowed

C. 12 hours, nothing but water allowed

77. Which of the following methods for HDL cholesterol is the reference method? A. Manganese-heparin B. Magnesium-phosphotungstate C. Magnesium-dextran D. Ultracentrifugation

D. Ultracentrifugation

78. What is the purpose of the saponification step used in the Abell-Kendall method for cholesterol measurement? A. Remove phospholipids B. Convert cholesterol esters to free cholesterol C. Reduce sterol molecules structurally similar to those of cholesterol D. Remove proteins that can interfere with color formation

C. Reduce sterol molecules structurally similar to those of cholesterol

79. A person has a fasting triglyceride level of 240 mg/dL. The physician wishes to know the patient’s non-HDL cholesterol level. What cholesterol fractions should be measured? A. Total cholesterol and HDL cholesterol B. Total cholesterol and LDL cholesterol C. HDL cholesterol and LDL cholesterol D. Total cholesterol and chylomicrons

B. Total cholesterol and LDL cholesterol

80. An International unit (IU) of enzyme activity is the quantity of enzyme that: A. Converts 1 µmol of substrate to product per liter B. Forms 1 mg of product per deciliter C. Converts 1 µmol of substrate to product per minute D. Forms 1 µmol of product per liter

C. Converts 1 µmol of substrate to product per minute

81. Which condition produces the highest elevation of serum lactate dehydrogenase? A. Pernicious anemia B. Myocardial infarction C. Acute hepatitis D. Muscular dystrophy

A. Pernicious anemia

82. Following an acute MI, activity of LD usually peaks: A. Within 1 day postinfarction and returns to normal after 3 days B. Twenty-four to 36 hours postinfarction and returns to normal after 3 days C. Forty-eight hours postinfarction and returns to normal after 4 days D. Three days postinfarction and returns to normal after 1 week

B. Twenty-four to 36 hours postinfarction and returns to normal after 3 days

83. Which of the following is the best analyte to monitor for recurrence of ovarian cancer? A. CA 15-3 B. CA 19-9 C. CA-125 D. Estrogen receptor (ER)

C. CA-125

84. Which of the following tumor markers is used to monitor persons with breast cancer for recurrence of disease? A. Cathepsin-D B. CA-15-3 C. Retinoblastoma gene D. Estrogen receptor (ER)

B. CA-15-3

85. What is the primary clinical utility of measuring CEA? A. Diagnosis of liver cancer B. Diagnosis of colorectal cancer C. Screening for cancers of endodermal origin D. Monitoring for recurrence of cancer

D. Monitoring for recurrence of cancer

86. Which set of results for ER and PR is associated with the highest likelihood of a favorable response to treatment with estrogen suppression therapy (tamoxifen)? A. ER positive, PR positive B. ER positive, PR negative C. ER negative, PR positive D. ER negative, PR negative

A. ER positive, PR positive

87. Which type of cancer is associated with the highest level of Alpha FetoProtein? A. Hepatoma B. Ovarian cancer C. Testicular D. Breast cancer

A. Hepatoma

88. Which of the following assays is recommended as a screening test for colorectal cancer in persons over 50 years old? A. CEA B. AFP C. Occult blood D. Fecal trypsin

C. Occult blood

89. Which of the following substances is used to determine the risk of developing cancer? A. Epidermal growth factor receptor (EGF-R) B. Squamous cell carcinoma antigen (SCC) C. c-erb B-2 gene D. p53

D. p53

90. A person has an elevated 24-hour urinary homovanillic acid (HVA) and vanillylmandelic acid (VMA). Urinary metanephrines, chromogranin A, and neuron-specific enolase are also elevated but 5-hydroxyindoleacetic acid is within the reference range. What is the most likely diagnosis? A. Carcinoid tumors of the intestine B. Pheochromocytoma C. Neuroblastoma D. Pancreatic cancer

C. Neuroblastoma

91. A 55 year old male with early stage prostate cancer diagnosed by biopsy had his prostate gland removed (simple prostatectomy). His PSA prior to surgery was 10.0 ng/mL. If the surgery was successful in completely removing the tumor cells, what would the PSA result be 1 month after surgery? A. Undetectable B. 1-3 ng/mL C. Less than 4 ng/mL D. Less than 10 ng/mL

A. Undetectable

92. A blood sample is left on a phlebotomy tray for 4 hours before it is delivered to the laboratory. Which group of test could still be performed? A. Glucose, Na, K, Cl, TCO₂ B. Uric acid, BUN, creatinine C. Total and direct bilirubin D. CK, ALT, ALP, ACP

B. Uric acid, BUN, creatinine

93. A quantitative urine glucose level was determined to be 160 mg/dL by the Trinder glucose oxidase method. The sample was refrigerated overnight. The next day, the glucose was repeated and found to be 240 mg/dL using a polarographic method. What is the most likely cause of this discrepancy? A. Poor precision when performing one of the methods B. Contamination resulting from overnight storage C. High levels of reducing substances interfering with the Trinder reaction D. Positive interference in the polarographic method caused by hematuria

C. High levels of reducing substances interfering with the Trinder reaction

94. A gastric fluid from a patient suspected of having taken an overdose of amphetamine is sent to the laboratory for analysis. The technologist should: A. Perform an EMIT assay for amphetamine B. Adjust the pH, and request serum or urine C. Dilute 1:10 with H₂O and filter; perform TLC for amphetamines D. Titrate to pH 7.0, then follow procedure for measuring amphetamine in urine

C. Dilute 1:10 with H₂O and filter; perform TLC for amphetamines

95. Analysis of normal and abnormal quality controls performed at the beginning of the evening shift revealed a 2s error across levels for triglyceride. Both controls were within the 3 standard deviation limit. The controls were assayed again, and one control was above the 2 standard deviation limit. No further action was taken, and the patient results that were part of the run were reported. Which statement best describes this situation? A. Appropriate operating procedures were followed B. Remedial evaluation should have been taken but otherwise the actions were appropriate C. Remedial action should have been taken and controls repeated with a fresh aliquot; at least three of the patient samples should have been repeated D. The controls should have been run twice before reporting results

C. Remedial action should have been taken and controls repeated with a fresh aliquot; at least three of the patient samples should have been repeated

96. A 6-year-old being treated with phenytoin was recently placed on valproic acid for better control of seizures. After the patient displayed signs of phenytoin toxicity, including ataxia, a stat phenytoin was determined to be 15.0 mg/L (reference range 10-20 mg/L), a peak blood level drawn 5 hours after the last dose is 18.0 mg/L. The valproic acid measured at the same time is within acceptable limits for all tests, but the accuracy of the results is questioned by the physician. What is the most appropriate next course of action? A. Repeat the valproic acid level using the last specimen B. Repeat the phenytoin on both trough and peak samples using a different method C. Recommend measurement of free phenytoin using the last specimen D. Recommend that a second trough level be measured

C. Recommend measurement of free phenytoin using the last specimen

97. Pick the INCORRECT Fire Safety Classification: A. Class A Fire = plastic & wood B. Class B Fire = petroleum products C. Class C Fire = oxygen & fuel D. Class D Fire = Sodium & Potassium

C. Class C Fire = oxygen & fuel

98. A 5ml blood specimen was extracted at 6:00AM today by a Phlebotomist. The Medical Laboratory Scientist in charge of the Chemistry section today will report to duty at 8:00AM. Which of the following statements is INCONSISTENT with the condition: A. The level of glucose in the specimen can be made stable by adding 5mg NaF at 6:00AM B. The anti-glycolysis function of any additive is insufficient with the presence of bacteria C. The level of glucose in the specimen will be 10mg/dl lower after the test is done D. The level of glucose in the specimen will be stable with the efflux of K⁺

C. The level of glucose in the specimen will be 10mg/dl lower after the test is done

99. The main advantages of fluorometric over spectroscopic methods of analysis are: A. Decreased specificity and decreased sensitivity B. Decreased specificity and increased sensitivity C. Increased specificity and increased sensitivity D. Increased specificity and decreased sensitivity

C. Increased specificity and increased sensitivity

100. Which type of fire extinguisher should be used on an electrical equipment fire? A. Type A B. Type B C. Type C D. Type E

C. Type C

101. Which is the most widely used screening test for Cushing’s syndrome? A. Overnight dexamethasone suppression test B. Corticotrophin-releasing hormone stimulation test C. Petrosal sinus sampling D. Metyrapone stimulation test

A. Overnight dexamethasone suppression test

102. Which statement about the diagnosis of Addison’s disease is true? A. Patients with primary Addison’s disease show a normal response to ACTH stimulation B. Primary and secondary Addison’s disease can often be differentiated by plasma ACTH C. Twenty-four-hour urinary free cortisol testing is normal in Addison’s disease D. Pituitary ACTH reserves are normal in secondary Addison’s disease

B. Primary and secondary Addison’s disease can often be differentiated by plasma ACTH

103. Which statement below applies to both measurement of VMA and Metanephrines in urine? a. Both can be oxidized to vanillin and measured at 360 nm without interference from dietary compounds b. Both can be measured immunochemically after hydrolysis and derivatization c. Both require acid hydrolysis prior to measurement d. Both can be measured by specific HPLC and GC-MS assays

d. Both can be measured by specific HPLC and GC-MS assays

104. Select the most appropriate single screening test for thyroid disease. A. Free thyroxine index B. Total T3 assay C. Total T4 D. TSH assay

D. TSH assay

105. A patient has an elevated serum T3 and Free T4 and a very low serum TSH. What is the most likely cause of these results? A. Primary hyperthyroidism B. Secondary hyperthyroidism C. Euthyroid with increased thyroxine-binding proteins D. Euthyroid sick syndrome

A. Primary hyperthyroidism

106. A serum thyroid panel reveals an increase in total T4, normal TSH, and normal free T4. What is the most likely cause of these results? A. Primary hyperthyroidism B. Secondary hyperthyroidism C. Euthyroid with increased thyroxine-binding protein D. Subclinical hypothyroidism

C. Euthyroid with increased thyroxine-binding protein

107. The term pharmacokinetics refers to the: A. Relationship between drug dose and the drug blood level B. Concentration of drug at its sites of action C. Relationship between blood concentration and therapeutic response D. The relationship between blood and tissue drug levels

A. Relationship between drug dose and the drug blood level

108. Select the five pharmacological parameters that determine serum drug concentration. A. Absorption, anabolism, perfusion, bioactivation, excretion B. Ingestion, equilibration, biotransformation, reabsorption, elimination C. Liberation, absorption, distribution, metabolism, excretion D. Ingestion, conjugation, integration, metabolism, elimination

C. Liberation, absorption, distribution, metabolism, excretion

109. For drugs with first-order elimination, which statement about drug clearance is true? A. Clearance = elimination rate ÷ serum level B. It is most often performed by the liver C. It is directly related to half-life D. Clearance rate is independent of dose

A. Clearance = elimination rate ÷ serum level

110. Which statement about EMIT is true? A. Enzyme activity is inversely proportional to drug level B. ALP is the commonly used conjugate C. Formation of NADH is monitored at 340 nm D. Assay use is restricted to serum

C. Formation of NADH is monitored at 340 nm

111. Which statement below regarding FPIA is true? A. Plane-polarize fluorescence is directly related to the drug level B. B-Galactosidase is commonly used to label the antigen C. Separation of free and bound labeled antigen is not required D. Assays are based upon the double antibody sandwich method

B. B-Galactosidase is commonly used to label the antigen

112. SITUATION: A urine sample is received in the laboratory with the appropriate custody control form for drug testing. What would be a cause for rejecting the sample? A. Temperature after collection 95°C B. pH of 5.0 C. Specific gravity of 1.005 D. Creatinine level of 5 mg/dL

D. Creatinine level of 5 mg/dL

113. Which of the following statements about blood alcohol symptoms of intoxication usually begin when measurement is correct? A. The level exceeds 0.05% w/v B. The skin puncture site should be disinfected with isopropanol C. The reference method is based upon enzymatic oxidation of ethanol by alcohol dehydrogenase D. Gas chromatography methods require extraction of ethanol from serum

A. The level exceeds 0.05% w/v

114. Which specimen is the sample of choice for lead screening? A. Whole blood B. Hair C. Serum D. Urine

A. Whole blood

115. Which of the following enzymes can be used to measure plasma or serum salicylate? A. Peroxidase B. Salicylate esterase C. Salicylate hydroxylase D. P-Aminosalicyclate oxidase

C. Salicylate hydroxylase

116. Which of the following tumor markers is classified as a tumor suppressor gene? A. BRCA-1 B. Carcinoembryonic antigen (CEA) C. Human chorionic gonadotropin (hCG) D. Nuclear matrix protein

A. BRCA-1

117. In general, in which of the following situations is the analysis of a tumor marker most useful? A. Testing for recurrence B. Prognosis C. Screening D. Diagnosis

A. Testing for recurrence

118. In the Hazards Identification System, four color-coded, diamond-shaped symbols are arranged to form a larger diamond shape. What type of hazard does the red diamond represent? A. Flammability B. Health C. Reactivity D. Universal

A. Flammability

119. A known normal patient has an increased serum glucose level. He could have taken which of these drugs? A. Calcium & Penicillin G B. Ascorbic Acid & Acetaminophen C. Isoniazid & Cephalosporins D. Erythromycin & Vitamin B

B. Ascorbic Acid & Acetaminophen

120. You see the following wastes in the following bins: Kopico candy wrappers in the yellow bin, carbon paper in the black bin, plastic spoon in the red bin, and used gloves & empty Coke tin can in the green bin. The next thing to do: A. Nothing, those wastes are in their right places. B. Notify the garbage collector of the wrong disposal of some wastes. C. Transfer the wrongly disposed wastes into their correct bins. D. Pour alcohol unto the wrongly disposed wastes to disinfect them.

C. Transfer the wrongly disposed wastes into their correct bins.

121. The Allen Correction or Dual Wavelength method A. Acorr = Apeak absobance – 2 / (Δ Analyte-free serum absorbance; lower & higher) B. Acorr = (Δ Analyte-free serum absorbance; lower & higher) / 2 – Apeak absorbance C. Apeak absorbance = Acorr – (Δ Analyte-free serum absorbance; lower & higher) D. Acorr = Apeak absorbance – (Δ Analyte-free serum absorbance; lower & higher) / 2

D. Acorr = Apeak absorbance – (Δ Analyte-free serum absorbance; lower & higher) / 2

122. What Westgard rule is violated in the Levey–Jennings control chart above? A. 7T B. 3:1s C. 1:2s D. No violation seen

C. 1:2s

123. What will you do next after looking at this particular control chart? A. Accept the run B. Reject the run C. Automatically repeat the control D. Careful inspection of the data since this is just a warning signal

D. Careful inspection of the data since this is just a warning signal

124. What Westgard rule is violated in the Levey–Jennings control chart above? A. 4:1s B. 3:1s C. 2:2s D. No rule is violated

D. No rule is violated

125. What is the next step after looking at the chart above? A. Accept the run B. Reject the run C. Repeat the control D. Investigate the cause

A. Accept the run

126. The order of elution in Cation-exchange chromatography: A. α₁-globulins, α₂-globulins, β-globulins, and albumin B. α₂-globulins, albumin, β-globulins, and α₁-globulins C. β-globulins, α₂-globulins, α₁-globulins, and albumin D. albumin, α₁-globulins, α₂-globulins, and β-globulins

D. albumin, α₁-globulins, α₂-globulins, and β-globulins

127. It is the preferred method for AST/ALT assays. A. Karmen or Walker B. Frankel-Reitman C. Babson D. Tanzer and Gilvarg

A. Karmen or Walker

128. The effects of adenylate cyclase on CK determination may be minimized by: A. Avoiding sample’s exposure to light B. Using red top tubes without anticoagulant C. Using a sulfhydryl activator D. Addition of diadenosine-5-pentaphosphate

C. Using a sulfhydryl activator

129. LD2 and LD3 are the two highest fractions, with high Aldolase and phosphohexose isomerase in this condition: A. Pulmonary Infarct B. Acute Hepatitis C. Metastatic Liver Cancer D. Myocardial Infarct

C. Metastatic Liver Cancer

130. Wroblewski-Cabaud method involved the following EXCEPT: A. The lactate produced is allowed to react with DNPH B. Product is golden brown phenyl hydrazine solution C. It uses an alkaline pH D. Absorbance measured at 440–525 nm

A. The lactate produced is allowed to react with DNPH

131. An outpatient was extracted at 6 AM. Unfortunately, the Med Tech in charge has to answer an emergency call in the Emergency Room, and has to leave the first patient’s blood in the refrigerator with its temperature at 4°C. If the patient’s fasting blood sugar yesterday was around 90 mg/dL, how much do you expect it to be, if the Med Tech was able to come back & perform the test at 9 AM? A. 80 mg/dL B. 76 mg/dL C. 84 mg/dL D. 69 mg/dL

C. 84 mg/dL

132. A patient was subjected to an Oral Glucose Tolerance Test, and has the following blood results: Fasting glucose 135 mg/dL, 1 ½ hour level of 200 mg/dL, and a 2-hr glucose value of 110 mg/dL. What is your diagnosis? A. Diabetes mellitus B. Normal C. Impaired D. None of the above

A. Diabetes mellitus

133. A patient’s HbA1c was 8%. Conclusion: A. Patient’s Diabetes is well-controlled by his diet B. The diabetic patient is not controlling his diet C. Patient is having gestational diabetes D. His diet has nothing to do with this test

B. The diabetic patient is not controlling his diet

134. A 6-month pregnant patient has the following result for the 3-hour OGTT: Fasting 100 mg/dL; 1 hour 220 mg/dL; 2 hour 200 mg/dL; 3 hours 135 mg/dL. Conclusion: A. Patient is positive for Non-insulin dependent Diabetes Mellitus B. Patient is positive for Juvenile Diabetes Mellitus C. Patient is negative for Gestational Diabetes Mellitus D. Patient is positive for Gestational Diabetes Mellitus

D. Patient is positive for Gestational Diabetes Mellitus

135. “Good” cholesterol pertains to the following lipoprotein A. HDL B. LDL C. IDL D. VLDL

A. HDL

136. A patient’s blood has been standing for 2 hours since the previous Med Tech on duty has left it beside the centrifuge by negligence. The next technologist performed the ammonia test which gives a result of 13.036 μg/mL. How much was its initial content and its actual interpretation? A. 11.036 μg/mL, increased B. 13.0 μg/mL, normal C. 13.0 μg/mL, increased D. 13.036 μg/mL, increased

C. 13.0 μg/mL, increased

137. This method of protein determination is based on the ability of phosphomolybdate complex acid to oxidize the phenolic structures of the amino acids tyrosine, phenylalanine, tryptophan and histidine: A. Coomassie Brilliant Blue Dye B. Lowry Protein Assay C. Folin-Ciocalteau Method D. Biuret Method

C. Folin-Ciocalteau Method

138. A 10 mL class A volumetric flask has an accuracy of ±0.2%. Express the ±0.2% tolerance in terms of milliliters. A. ±0.002 B. ±0.01 C. ±0.02 D. ±0.2

C. ±0.02

139. Protein-losing enteropathy is usually seen in malabsorption syndrome and is evidenced by a serum electrophoretogram of: A. Albumin only B. Low albumin and gamma globulin C. Low albumin and gamma globulin, high alpha-1 and 2 globulins D. Low albumin and gamma globulin, high alpha-2 globulin

D. Low albumin and gamma globulin, high alpha-2 globulin

140. To correct for interfering nucleic acids, the protein concentration may be calculated using this formula: A. Protein (mg/mL) = (15.5 x A₂₈₀) – (0.67 x A₂₆₀) B. Protein (mg/mL) = (1.55 x A₂₈₀) – (0.76 x A₂₆₀) C. Protein (mg/mL) = (0.76 x A₂₆₀) – (1.55 x A₂₈₀) D. Protein (mg/mL) = (1.55 x A₂₆₀) – (0.76 x A₂₈₀)

B. Protein (mg/mL) = (1.55 x A₂₈₀) – (0.76 x A₂₆₀)

141. A level of free haptoglobin suggests hemoglobinemia or hemolysis: A. Decrease in serum B. Increase in serum C. Decrease in urine D. Increase in urine

A. Decrease in serum

142. In anion-exchange chromatography, the order of elution is usually: A. α₁-globulins, α₂-globulins, β-globulins, and albumin B. α₂-globulins, albumin, β-globulins, and α₁-globulins C. β-globulins, α₂-globulins, α₁-globulins, and albumin D. Albumin, α₁-globulins, α₂-globulins, and β-globulins

C. β-globulins, α₂-globulins, α₁-globulins, and albumin

143. This abnormal lipoprotein accumulates in type 3 hyperlipoproteinemia A. LpX Lipoprotein B. Lp (A) C. VLDL D. β-VLDL

D. β-VLDL

144. The reaction of formaldehyde with ammonium ion and acetylacetone to produce yellow-colored product diacetyl is the final step of what triglyceride method? A. Van Handel and Zilversmit reaction B. Hantzsch condensation reaction C. Standard colorimetric reaction D. Liebermann burchard reaction

B. Hantzsch condensation reaction

145. In severe liver disease the ratio of esterified cholesterol to total cholesterol is altered because the esterification of cholesterol by the liver is depressed. To quantitate cholesteryl esters, it is necessary to precipitate the free cholesterol by use of A. Potassium hydroxide B. Isopropyl alcohol C. Sodium hydroxide D. Digitonin

C. Sodium hydroxide

146. The lecithin/sphingomyelin ratio is a determination that is frequently performed to assess A. Arteriosclerosis B. Hyperlipidemia C. Coronary artery disease D. Fetal lung maturity

D. Fetal lung maturity

147. In the Berthelot reaction, a blue-indigo compound is formed that is proportional to the quantity of urea in the specimen being analyzed. Falsely elevated urea values will occur with this procedure when the reaction mixture is contaminated by: A. Glucose B. Protein C. Ammonia D. Bacteria

C. Ammonia

148. Patient's test for serum triglyceride this morning resulted to 250 mg/dL. Later in the afternoon, you remembered you didn't remove the free glycerol. How much should his result be if only urea is removed? A. 182.5-195 mg/dL B. 82.5-95 mg/dL C. 105-110.5 mg/dL D. 215-110 mg/dL

D. 215-110 mg/dL

149. In determining the Lipid Profile, which procedure / computation is NOT acceptable? A. Determine first TAG, and total cholesterol HDL-cholesterol by chemical means B. Total cholesterol = intranatant cholesterol – TAG C. VLDL-cholesterol = total cholesterol – intranatant cholesterol D. LDL-cholesterol = intranatant cholesterol – HDL-cholesterol

B. Total cholesterol = intranatant cholesterol – TAG

150. Ceruloplasmin contains which metal? A. Magnesium B. Copper C. Iron D. Zinc

B. Copper

151. The 5'N in Bone Disease a. decreased b. normal c. increased d. no relationship

b. normal

152. The LAP in Bone Disease a. decreased b. normal c. increased d. no relationship

b. normal

151. The GGT in Liver DIsease a. decreased b. normal c. increased d. no relationship

b. normalc. increased

154. Acute alcoholism leads to: A. Hypokalemia B. Hypomagnesemia C. Hypophosphatasia D. A & B

D. A & B

155. Menkes kinky hair syndrome is due to a genetic defect of this metal: A. Copper B. Magnesium C. Manganese D. Phosphates

A. Copper

156. Toxicity to the dust of this metal results in basal ganglia damage and produces both psychological and neurological symptoms: A. Nickel B. Magnesium C. Manganese D. Phosphates

C. Manganese

157. These ions exhibit diurnal variations: A. Cobalt & Copper B. Magnesium & Molybdenum C. Phosphates & Iron D. Zinc & Iodine

C. Phosphates & Iron

158. Which statement is TRUE regarding regulation of ions: A. In hypercalcemia, there is hypophosphatasia, which in turn may be seen in hyperparathyroidism. B. In hypocalcemia, there is hypophosphatasia, which in turn may be seen in hyperparathyroidism. C. In hypercalcemia, there is hyperphosphatasia, which in turn may be seen in hypoparathyroidism. D. In hypocalcemia, there is hypophosphatasia, which in turn may be seen in hypoparathyroidism.

A. In hypercalcemia, there is hypophosphatasia, which in turn may be seen in hyperparathyroidism.

159. A 2-week-old female patient’s test for serum copper has a result of 1.00 µg/dL. How much is her serum copper level in µmol/L? A. 15.7 µmol/L B. 17.5 µmol/L C. 15.7 µmol/L D. 1.57 µmol/L

D. 1.57 µmol/L

160. A 25 y.o. female patient has the following test results: TIBC 300 µg/dL; serum iron 45 µg/dL. Interpret her % transfer in result. A. Normal B. Increased C. Decreased D. Can't be determined

C. Decreased

161. Given an arterial blood with pCO2 of 40 mmHg and a total of CO2 of 30 mmol/L, determine the HCO3 concentration: A. 1.2 mmol/L B. 18.8 mmol/L C. 24 mmol/L D. 14.6 mmol/L

A. 1.2 mmol/L

162. State the patient’s condition with the following findings: Negative HBsAg; retained increases in hepatic aminotransferase levels; low levels of HBV DNA; low to negative anti-HBs. A. Isolated Anti-HBc during Window Period Following Acute Infection B. Resolved HBV Infection with Waning Anti-HBs C. Persistent HBV Infection w/ Absent Detectable HBsAg D. Negative for Hep B infection; Passive reaction to vaccination

A. Isolated Anti-HBc during Window Period Following Acute Infection

163. The sample of choice for acid phosphatase assay: A. Citrated plasma B. Serum C. Oxalated plasma D. Heparinized plasma

A. Citrated plasma

164. Indicator used in Amyloclastic Method for Amylase Assay: A. Phenolphthalein B. Iodine C. Fluoride D. Thymolphthalein

B. Iodine

165. The level of this enzyme is a sensitive measure of overexposure to organophosphorus poisoning: A. True cholinesterase B. Glucose-6-Phosphate Dehydrogenase C. Lipase D. Pseudo-cholinesterase

D. Pseudo-cholinesterase

166. In the Colorimetric Test for G6PD, a ___ ring is seen in deficient samples. A. Yellow B. Violet C. Blue D. Red

A. Yellow

167. A potassium determination revealed a result of 5.8 mmol/L. However, the Med Tech on duty noticed that the sample he used has some blood clots at the bottom of the tube. Determine the patient’s actual potassium level: A. Hypokalemia B. Normal C. Hyperkalemia D. Cannot be determined

C. Hyperkalemia

168. A patient’s chloride determination, on sample labeled as “CSF”, resulted to 100 mmol/L. Interpret the result. A. Bacterial meningitis B. Protein concentration in cerebrospinal fluid is low C. There are practically no protein anions in the CSF D. None

A. Bacterial meningitis

169. Usual Serum Osmol Ratio of patients with Chronic Renal Insufficiency: A) > 20 mEq/L B) < 20 mEq/L C) < 1.2 mEq/L D) > 1 mEq/L

A) > 20 mEq/L

170. Cyfra 21-1 A) ↑ rapid cell turnover B) ↑ membranes of drug-resistant cells C) ↑ iron metabolism and erythropoiesis D) ↑ non-small cell lung cancer

D) ↑ non-small cell lung cancer

171. α1-glycoprotein A) ↑ insulinoma B) ↑ thyroid carcinoma C) ↑ urinary free immunoglobulin light chains D) ↑ marker of cellular proliferation

B) ↑ thyroid carcinoma

172. Ferritin A) ↑ rapid cell turnover B) ↑ membranes of drug-resistant cells C) ↑ iron metabolism and erythropoiesis D) ↑ non-small cell lung cancer

C) ↑ iron metabolism and erythropoiesis

173. Beta2-microglobulin A) ↑ insulinoma B) ↑ thyroid carcinoma C) ↑ urinary free immunoglobulin light chains D) ↑ marker of cellular proliferation

A) ↑ insulinoma

174. C-peptide A) ↑ insulinoma B) ↑ thyroid carcinoma C) ↑ urinary free immunoglobulin light chains D) ↑ marker of cellular proliferation

A) ↑ insulinoma

175. Bence Jones protein A) ↑ insulinoma B) ↑ thyroid carcinoma C) ↑ urinary free immunoglobulin light chains D) ↑ marker of cellular proliferation

C) ↑ urinary free immunoglobulin light chains

176. Thyroglobulin A) ↑ insulinoma B) ↑ thyroid carcinoma C) ↑ urinary free immunoglobulin light chains D) ↑ marker of cellular proliferation

B) ↑ thyroid carcinoma

177. Tissue polypeptide antigen A) ↑ insulinoma B) ↑ thyroid carcinoma C) ↑ urinary free immunoglobulin light chains D) ↑ marker of cellular proliferation

D) ↑ marker of cellular proliferation

178. Interpret the following result for Nicotine Tests: A) Positive B) Negative C) Invalid

B) Negative

179. Same as 178 (new test strip shown): A) Positive B) Negative C) Invalid

B) Negative

180. Same as above: A) Positive B) Negative C) Invalid

A) Positive

181. Same as above: A) Positive B) Negative C) Invalid

C) Invalid

Patients with normal ADH responses should not have weight losses greater than 182.___% and the decrease in water intake should 183.____ the release of ADH. 182.___ A) 3% B) 1% C) 5% D) Inhibit

A) 3%

Patients with normal ADH responses should not have weight losses greater than 182.___% and the decrease in water intake should 183.____ the release of ADH. 183.___ A) 3% B) 1% C) 5% D) Inhibit

B) 1%

Melatonin has an 184.___ effect with GnRH on the pituitary-gonadal axis, in which in that 185._____ level of melatonin is needed for the maturation of gonads. 184._____ A) Decreased B) Similar C) Opposite D) Increased

C) Opposite

Melatonin has an 184.___ effect with GnRH on the pituitary-gonadal axis, in which in that 185._____ level of melatonin is needed for the maturation of gonads. 185._____ A) Decreased B) Similar C) Opposite D) Increased

A) Decreased

Prolactin levels are highest in the 186.___ but 187.____ also if the patient is under stress. 186. _____ A) Increases B) Morning C) Decreases D) Midnight

B) Morning

Prolactin levels are highest in the 186.___ but 187.____ also if the patient is under stress. 187. _____ A) Increases B) Morning C) Decreases D) Midnight

A) Increases

FSH stimulates the growth of follicle, while 188.___ stimulates it to become a corpus luteum. The follicle cells produce 189.___ which in turn has a positive feedback effect on the secretion of 190.___ 188.____ A) GnRH B) Progesterone C) LH D) Estrogen

C) LH

A) GnRH

D) Estrogen

191. In the definitive drug confirmation testing this identifies the exact molecular structure of the compounds: A) Gas chromatography B) Flame photometry C) Mass spectrometry D) A & C only

C) Mass spectrometry

192. Hair provides a ___ history of the donor’s drug use. A) 15-day B) 30-day C) 60-day D) 90-day

D) 90-day

193. Barbiturates peak absorbance 320 nm and at 220 nm is achieved by adjusting the pH with: A) 0.45 mol/L NaCl B) 4.5 mol/L KOH C) 4.5 mol/L NaOH D) 0.45 mol/L NaOH

D) 0.45 mol/L NaOH

194. The colorimetric method for Lead that uses diphenylthiocarbazone (dithizone) leads to formation of ___ complex. A) Red B) Violet C) Yellow D) Blue

A) Red

195. A person with a very high BAC of .165 will have no measurable alcohol in the bloodstream after ___ hours. A) 10 B) 1.0 C) 1.1 D) 11

D) 11

196. It is considered the reference method for measuring steroids: A) Fluorescence polarization immunoassay B) Enzyme-multiplied immunologic technique C) Gas chromatography–mass spectrometry D) High performance liquid chromatography

D) High performance liquid chromatography

197. The principal end-product of dopamine metabolism is: A) Vanillyl Mandelic Acid B) Positive, EMIT C) Homovanillic acid D) L-Monoamine oxidase

C) Homovanillic acid

198. Anti-drug + Serum + drug-fluorescein complex → free drug-fluorescein complex. Irradiate with polarized light, and there will be a decreased polarization. A) Negative, Ames B) Positive, EMIT C) FPIA Negative D) FPIA Positive Result

D) FPIA Positive Result

199. Serum + anti-drug + drug-enzyme complex → anti-drug-drug + free drug-enzyme complex. Add substrate, there will be a color change. A) Negative, Ames B) Positive, EMIT C) FPIA Negative D) FPIA Positive Result

B) Positive, EMIT

200. Sample + anti-drug + drug-substrate complex → anti-drug + substrate. Addition of enzyme β-galactosidase → fluorescence is decreased or absent. A) Negative, Ames B) Positive, EMIT C) FPIA Negative D) FPIA Positive Result

A) Negative, Ames

201. This is NOT a finding in Healthy Carriers of Hepatitis B: A) HBsAg (+) B) Anti-HBc (+) C) Elevated ALT D) HBV DNA (+)

C) Elevated ALT

202. Facts regarding enzymatic assays EXCEPT: A) If only one substance reacts, the rate is proportional to concentration of that one substance. B) It is important to measure the rate when it is curvilinear. C) Substrate in large amounts may act as an enzyme inhibitor. D) Specimens used should be serum except for ACP.

B) It is important to measure the rate when it is curvilinear.

203. A 56-year-old male patient, who complains of left chest pain radiating to the left arm, showed the following laboratory result: CPK low but still above normal; SGOT very high; ALD very high; LDH now but already above normal. Give the most probable timing of the myocardial infarct: A) First day B) Third day C) One week D) Tenth day

B) Third day

204. If an isotope has a half-life of 6 hours and an activity of 16 mCi (millicuries), its activity will drop to ___ in 18 hours: A) 1.5 mCi B) 2 mCi C) 3 mCi D) 0.75 mCi

B) 2 mCi

205. These analytes are sensitive to light and must be kept in dark or opaque containers: A) Catecholamines & bilirubin B) Ammonia & amylase C) Urea & bilirubin D) Potassium & blood gases

C) Urea & bilirubin

206. The following may be used to test hepatocyte INTEGRITY alone EXCEPT: A) Glutamic pyruvic transaminase B) Isocitrate dehydrogenase C) Gamma glutamyl transpeptidase D) Leucine aminopeptidase

C) Gamma glutamyl transpeptidase

207. Given the patient’s condition: (Note: there is a graph in the image showing a protein electrophoresis pattern) A) Acute Liver Disease B) Renal Disease C) Myocardial Infarction D) Pernicious Anemia

A) Acute Liver Disease

208. Blood containing bromide would give a false positive result on the determination of this electrolyte: A) Sodium B) Potassium C) Chloride D) Lithium

C) Chloride

209. Blood gas determination of patient Pedro Gil gives the following result: pH < 7.4; bicarbonate = low; PCO₂ = low. Give the interpretation: A) Metabolic acidosis B) Metabolic alkalosis C) Respiratory acidosis D) Respiratory alkalosis

A) Metabolic acidosis

210. Blood gas determination of patient Juan de la Cruz gives the following result: pH > 7.4; bicarbonate = low; PCO₂ = low. Give the interpretation: A) Metabolic acidosis B) Metabolic alkalosis C) Respiratory acidosis D) Respiratory alkalosis

D) Respiratory alkalosis

211. In stone analysis, if a yellow-orange colored product is produced from the following procedure: acid extract + NaOH + neocuporine + HAc + CuSO₄, then the stone could be made up of: A) Uric acid B) Calcium C) Ammonium D) Cysteine

A) Uric acid

212. A 2 mmHg change in PaCO₂ above 40 mmHg could result in the following: A) 0.016 decrease in pH B) 0.016 increase in pH C) 0.008 decrease in pH D) 0.008 increase in pH

A) 0.016 decrease in pH

213. Contraindications for Radial Artery Extraction EXCEPT: A) Coagulation defects B) Adequate collateral circulation C) Infection in sampling area D) When cannulation of that vessel is anticipated

B) Adequate collateral circulation

214. A patient’s urine specific gravity, on a hot sunny day (32°C), was read at 1.010 using a urinometer. What is the actual specific gravity of the patient’s urine? A) 1.006 B) 1.014 C) 1.001 D) 1.010

B) 1.014

215. Sources of error for creatinine clearance EXCEPT: A) Presence of inulin in sample B) Improper hydration – negative error C) Faulty timing or collection D) Vigorous exercise alters rate

A) Presence of inulin in sample

216. Regarding osmolality, 2 moles of any nonionic substance dissolved in 1 kg water would lower the freezing point by: A) 1.86°C B) 3.72°C C) 1.86°F D) 3.72°F

D) 3.72°F

217. Na, K, & Li emit light of distinctive wavelengths – ___ nm respectively: A) 768, 672, 590 nm B) 672, 590, 768 nm C) 768, 590, 672 nm D) 590, 768, 672 nm

D) 590, 768, 672 nm

218. Reagents, standards and dilutions to be used for electrolyte measurement must be made with high purity water or deionized water with electrolyte content of: A. more than 5.0 ppm B. equal to 0.5 ppm C. less than 0.5 ppm D. less than 5.0 ppm

C. less than 0.5 ppm

219. In a microscope with a fixed tube length of 160 mm, the magnification obtained with a 4x objective and a 10x ocular would be: A. 160 B. 430 C. 1600 D. 68,800

B. 430

220. In steroid analysis the following urine creatinine level for a 24-hour urine, ensures the completeness of urine collection: A. Male = 1000–1900 mg; Female = 800–1700 mg B. Male = 800–1700 mg; Female = 1000–1900 mg C. Male = 1000–1700 mg; Female = 1000–1900 mg D. Male = 800–1900 mg; Female = 1000–1700 mg

A. Male = 1000–1900 mg; Female = 800–1700 mg

221. Which of the following is a sialylated Lewis blood group antigen associated with colorectal carcinoma? A. CA 549 B. CA 125 C. CA 19-9 D. CEA

C. CA 19-9

222. A male patient, 48 years old, mentions during his annual physical that he has been having difficulty urinating. The physician performs a rectal examination, and he orders a total prostate-specific antigen (PSA) and free PSA. The patient has the test done the following week, and the total PSA result is 3.1 ng/mL and the free PSA is 0.3 ng/mL. What do these results suggest? A. Both are normal, no disease present B. Benign prostatic hypertrophy C. Increased risk of prostate cancer D. Free PSA is low and does not correlate PSA

C. Increased risk of prostate cancer

223. Which test, if elevated, would provide information about risk for developing coronary artery disease? A. Troponin B. CK-MB C. hs-CRP D. Myoglobin

C. hs-CRP

224. Lactate dehydrogenase (LD) catalyzes the following reaction: Lactate + NAD⁺ → pyruvate + NADH As the reaction is written, which of the following techniques can be used to assess LD activity? A. Measure the colorimetric product pyruvate B. Measure the colorimetric product NADH C. Measure the increase in absorbance at 340 nm as NADH is produced D. Measure the decrease in absorbance at 340 nm as NADH is produced

C. Measure the increase in absorbance at 340 nm as NADH is produced

225. A 42-year-old male presents with anorexia, nausea, fever, and icterus of the skin and mucous membranes. He noticed that his urine had appeared dark for the past several days. The physician orders a series of biochemical tests. Based on the following test results, what is the most likely diagnosis? (Serum alkaline phosphatase – slightly elevated Serum alanine aminotransferase – markedly elevated Serum aspartate aminotransferase – slightly elevated Serum total bilirubin – positive) A. Acute hepatitis B. Alcoholic cirrhosis C. Metastatic carcinoma of the pancreas D. Obstructive jaundice

A. Acute hepatitis

226. When an AMI occurs, in what order (list first to last) will the enzymes aspartate aminotransferase (AST), certain kinase (CK), and lactate dehydrogenase (LD) become elevated in the serum? A. AST, LD, CK B. CK, LD, ACT C. CK, AST, LD D. LD, CK, AST

C. CK, AST, LD

227. The laboratory receives a request that assays for urinary aminolevulinic acid, porphobilinogen, uroporphyrin, and coproporphyrin are to be performed on a patient. Which of the following will not contribute to the integrity of the sample when the assays are performed on the same specimen? A. Refrigeration B. Addition of hydrochloric acid C. 24-hour urine collection D. Use of a brown bottle

B. Addition of hydrochloric acid

228. Indirect-reacting bilirubin may be quantified reacted initially in which reagent? A. Dilute hydrochloric acid B. Dilute sulfuric acid C. Caffeine-sodium benzoate D. Sodium hydroxide

C. Caffeine-sodium benzoate

229. Which of the following tests is least consistent with a diagnosis of viral hepatitis? A. Serum total bilirubin 7.5 mg/dL, direct bilirubin 5.5 mg/dL, indirect bilirubin 2.0 mg/dL B. Urine urobilinogen increased C. AST increased 10 times the upper limit of the reference range D. ALT increased 13 times the upper limit of the reference range

C. AST increased 10 times the upper limit of the reference range

230. The presence of only slightly visible hemolysis will significantly increase the serum level of which of the following electrolytes? A. Sodium B. Potassium C. Chloride D. Bicarbonate

B. Potassium

231. Using the following data: Na⁺ = 143 mmol/L; K⁺ = 4.9 mmol/L; Cl⁻ = 105 mmol/L; and HCO₃⁻ = 25 mmol/L, which of the following statements is false? A. Patient’s results are not acceptable B. Anion gap is useful in detecting disease states C. Anion gap equals 18 mmol/L D. Anion gap is useful in detecting analytical error

C. Anion gap equals 18 mmol/L

232. Primary aldosteronism results from a tumor of the adrenal cortex. How could the extracellular fluid be affected? A. Normal sodium, decreased potassium levels B. Decreased sodium, decreased potassium levels C. Decreased sodium, increased potassium levels D. Increased sodium, decreased potassium levels

D. Increased sodium, decreased potassium levels

233. A patient’s serum inorganic phosphate level is found to be elevated but the physician cannot determine a physiological basis for this abnormal result. What could possibly have caused an erroneous result to be reported? A. Patient not fasting when blood was drawn B. Specimen was hemolyzed C. Effect of diurnal variation D. Patient receiving intravenous glucose

B. Specimen was hemolyzed

234. In iron-deficiency anemia, what would be the expected percent saturation of transferrin with iron? A. Less than 15 B. Between 30 and 40 C. Between 40 and 50 D. Greater than 50

A. Less than 15

235. Which of the following disorders is best characterized by these laboratory results? (Serum iron — decreased Serum TIBC — increased Serum ferritin — decreased Transferrin saturation — decreased Free erythrocyte protoporphyrin — increased) A. Anemia of chronic disease B. Thalassemia C. Iron-deficiency anemia D. Hemochromatosis

C. Iron-deficiency anemia

236. Which of the following constituents normally present in serum must be chemically eliminated so that it will not interfere with the measurement of serum magnesium? A. Calcium B. Chloride C. Iron D. Potassium

A. Calcium

237. How would blood gas parameters change if a sealed specimen is left at room temperature for 2 or more hours? A. PO₂ increases, PCO₂ increases, pH increases B. PO₂ decreases, PCO₂ decreases, pH decreases C. PO₂ decreases, PCO₂ increases, pH decreases D. PO₂ increases, PCO₂ increases, pH decreases

C. PO₂ decreases, PCO₂ increases, pH decreases

238. The bicarbonate concentration may be calculated from the total CO₂ and PCO₂ blood levels by using which of the following formulas? A. 0.03 × (PCO₂ – total CO₂) B. 0.03 × (total CO₂ + PCO₂) C. total CO₂ – (0.03 × PCO₂) D. total CO₂ – PCO₂

C. total CO₂ – (0.03 × PCO₂)

239. Which of the following will cause a shift of the oxygen dissociation curve to the right, resulting in a decreased affinity of hemoglobin for O₂? A. Low plasma pH level B. Low PCO₂ level C. Low concentration of 2,3-bisphosphoglycerate D. Low temperature

A. Low plasma pH level

240. Given the following information, calculate the blood pH: PCO₂ = 44 mm Hg Total CO₂ = 29 mmol/L A. 6.28 B. 6.76 C. 7.42 D. 7.44

C. 7.42

241. Blood gases are drawn on a 68-year-old asthmatic who was recently admitted for treatment of a kidney infection. Blood gas results are as follows: pH = 7.25, PCO₂ = 56 mm Hg, HCO₃⁻ = 16 mmol/L What condition is indicated by these results? A. Metabolic alkalosis, partially compensated B. Respiratory acidosis, uncompensated C. A dual problem of acidosis D. An error in one of the blood gas measurements

C. A dual problem of acidosis

242. Plasma renin activity (PRA) measurements are usually made by measuring which of the following using immunoassay? A. Angiotensinogen B. Angiotensin I C. Angiotensin II D. Angiotensin-converting enzyme

B. Angiotensin I

243. What effect would a low-salt diet, upright position, and diuretics have on the following test results? A. Renin increased, aldosterone increased, hypernatremia, hypokalemia B. Renin increased, aldosterone decreased, hypernatremia, hypokalemia C. Renin decreased, aldosterone decreased, hyponatremia, hyperkalemia D. Renin decreased, aldosterone increased, hyponatremia, hyperkalemia

A. Renin increased, aldosterone increased, hypernatremia, hypokalemia

244. What does the concentration of urinary free cortisol mainly reflect? A. Total serum cortisol B. Conjugated cortisol C. Unbound serum cortisol D. Protein-bound serum cortisol

C. Unbound serum cortisol

245. Which of the following is the most common cause of the adrenogenital syndrome called congenital adrenal hyperplasia, and which test is used for its diagnosis? A. 17α-hydroxylase deficiency; progesterone assay B. 21-hydroxylase deficiency; 17α-hydroxyprogesterone assay C. 3β-hydroxysteroid dehydrogenase isomerase deficiency; 17α-hydroxypregnenolone assay D. 11β-hydroxylase deficiency; 11-deoxycortisol assay

B. 21-hydroxylase deficiency; 17α-hydroxyprogesterone assay

246. During pregnancy in the second trimester, human chorionic gonadotropin (hCG) levels ___ and progesterone and estriol levels ___ A. Increase, increase B. Increase, decrease C. Decrease, increase D. Decrease, decrease

C. Decrease, increase

247. Because of infertility problems, a physician would like to determine when a woman ovulates. The physician orders serial assays. How can the physician recognize when ovulation occurs? A. After ovulation, progesterone rapidly increases B. After ovulation, progesterone rapidly decreases C. Right before ovulation, progesterone rapidly increases D. There is a gradual, steady increase in progesterone throughout the menstrual cycle

A. After ovulation, progesterone rapidly increases

248. During pregnancy, estriol is synthesized in the placenta from ___ formed in the ___ A. Estradiol, mother B. Estradiol, fetus C. 16α-hydroxy-DHEA-S, fetus D. 16α-hydroxy-DHEA-S, mother

C. 16α-hydroxy-DHEA-S, fetus

249. In a patient who is suspected of having pheochromocytoma, measurement of which of the following would be the most useful? A. Metanephrine B. Homovanillic acid C. 5-Hydroxyindoleacetic acid D. Homogentisic acid

A. Metanephrine

250. Diabetes insipidus is associated with depressed secretion of which of the following hormones? A. Prolactin B. Antidiuretic C. Growth hormone D. Oxytocin

B. Antidiuretic

251. A 4-year-old female presents with a palpable abdominal mass, pallor, and petechiae. Based on family history, clinical findings, and the patient’s physical examination, neuroblastoma is suspected. Which of the following does not support such a diagnosis? A. Increased blood dopamine levels B. Increased blood epinephrine levels C. Increased urinary homovanillic acid D. Decreased urinary vanillylmandelic acid

D. Decreased urinary vanillylmandelic acid

252. Which of the following is an autoantibody that binds to TSH receptor sites on thyroid cell membranes, preventing thyroid-stimulating hormone from binding? A. Antithyroglobulin antibodies B. Thyroid antimicrosomal antibodies C. Thyrotropin-receptor antibodies D. Antithyroid peroxidase antibodies

C. Thyrotropin-receptor antibodies

253. In a patient with suspected primary hyperthyroidism associated with Graves disease, one would expect the following laboratory serum results: free thyroxine (FT4) ___, thyroid hormone binding ratio (THBR) ___ and thyroid-stimulating hormone (TSH) ___ A. Increased, decreased, increased B. Increased, decreased, decreased C. Increased, increased, decreased D. Decreased, decreased, increased

C. Increased, increased, decreased

254. When performing surgery for adenoma resection, parathyroid hormone is quantified at three points relative to the surgical procedure: baseline prior to incision, second baseline with gland exposure, and third sample at post-excision. Which of the following is not correct in assessing the PTH values? A. The second baseline value should be higher than the first baseline B. The first baseline value should be the highest value of the three samples C. The post-excision value should be at least 50% of or lower than the second baseline D. The lack of decrease in the PTH value post-excision indicates possible multigland disease

B. The first baseline value should be the highest value of the three samples

255. Which of the following tests would be particularly useful in determining isopropanol exposure? A. Serum osmolality and urine acetone B. Urine acetone and urine osmolality C. Urine osmolality and serum acetone D. Serum sodium and serum osmolality

A. Serum osmolality and urine acetone

256. Heroin is synthesized from what drug? A. Diazepam B. Morphine C. Ecgonine D. Chlorpromazine

B. Morphine

257. THC (Δ⁹-tetrahydrocannabinol) is the principal active component of what drug? A. Benzodiazepine B. Marijuana C. Morphine D. Codeine

B. Marijuana

258. What is the approximate number of half-life periods required for a serum drug concentration to reach 97–99% of the steady state? A. 1–3 B. 2–4 C. 5–7 D. 7–9

C. 5–7

259. Which of the following techniques is more commonly used to measure vitamins? A. High-performance liquid chromatography B. Spectrophotometry C. Nephelometry D. Microbiological

A. High-performance liquid chromatography

260. Measuring which of the following compounds is useful in the diagnosis of steatorrhea? A. Vitamin B12 B. Vitamin C C. Carotenoids D. Folic acid

C. Carotenoids

CC PART 2 Flashcards

(260 cards)